The Use of Telemedicine to Support Interventional Pain Care: Case Series and Commentary.

Incorporating indicated interventions in a multimodal approach to manage musculoskeletal pain has become standard of care. For example, in patients with radicular pain associated with intervertebral disc herniation or lumbar spinal stenosis, epidural steroid injections (ESI) are commonly used and often improve pain and function while avoiding more invasive surgical approaches. Recently, the coronavirus disease 2019 (COVID-19) pandemic has allowed remote evaluations to mitigate COVID-19 transmission using telemedicine.

Operationalizing Multidisciplinary Assessment and Treatment as a Quality Metric for Interventional Pain Practices.

Objective: Quality improvement (QI) is an underutilized approach among pain medicine specialists to improve comprehensive pain assessment and the delivery of multimodal pain care. We report the results of a QI program that utilized peer review and financial incentives to improve these processes in interventional pain clinics.

Design: Retrospective chart review.

A dose-determining trial of heparinase-I (Neutralase) for heparin neutralization in coronary artery surgery.

Unlabelled: Heparinase-I, a specific heparin-degrading enzyme, may represent an alternative to protamine. We explored the dose of heparinase-I for efficacy and safety in patients undergoing coronary artery surgery. At the conclusion of cardiopulmonary bypass, subjects received 5, 7, or 10 microg/kg of open-label heparinase-I instead of protamine.

The clinical onset of heparin is rapid.

This study used the activated clotting time (ACT) to determine the clinical onset of four different doses of heparin after bolus injection into the central circulation. Ten consenting adults (Group A) undergoing coronary artery bypass grafting were given 350 U/kg of bovine lung heparin and had simultaneous duplicate arterial and venous ACT determinations at baseline and at 30, 60, 90, 120, 180, and 600 s after heparin injection. Twenty additional coronary artery bypass grafting patients were alternately assigned to one of two 10-patient groups (B and C), which were given 200 and 300 U/kg of bovine lung heparin, respectively.

Minimally invasive direct coronary artery bypass: anesthetic, monitoring, and pain control considerations.

Objective: Minimally invasive direct coronary artery bypass (MIDCAB) provides many anesthetic challenges including monitoring, managing myocardial ischemia, and pain control. The objective was to evaluate the monitoring requirements and the potential benefits of preischemic conditioning and intrathecal morphine sulfate in MIDCAB patients.

Design And Setting: This review was retrospective and unrandomized and was conducted at Allegheny University Hospitals, Allegheny General, Pittsburgh, PA.

Intraoperative interstitial radiation therapy for hepatic metastases from colorectal carcinomas.

Liver metastases from colorectal carcinomas occur frequently. While surgical resection offers the only hope for long-term cure, unsuspected bilobar metastases or extrahepatic metastatic disease may be found at laparotomy, precluding hepatic resection for cure. In this setting intraoperative interstitial hepatic irradiation using the Gamma Med II (Mick Radio-Nuclear Instruments, Bronx, New York) remote afterloading irradiator and an Iridium-192 source permits delivery of a tumoricidal dose to liver tumor(s) with a limited radiation dose to adjacent normal liver.

Intraoperative single-dose radiotherapy. Observations on staging and interstitial treatment of unresectable liver metastases.

Fourteen patients with a history of colonic cancer were evaluated for metastatic disease and were thought to have unresectable disease confined to the liver. Exploratory surgery revealed that two patients had extensive extrahepatic disease, and the procedure was terminated. In 12 patients, closed-end needles (diameter, 2.

Crohn's appendicitis in an incarcerated spigelian hernia.

A patient with incarcerated Crohn's appendicitis and a spigelian hernia is presented, representing the challenge in diagnosis, incision choice, and choice of definitive surgical procedure. While it is unlikely that the report of such a patient's course will make prospective recognition of this rare entity more likely, a systematic approach to this patient has allowed a satisfactory result with minimal complications.

Creation of a subcutaneous tunnel for Broviac and Hickman catheters.

The use of the Cordis shunt tunneler has simplified the creation of the subcutaneous tunnel for chronic venous access catheters. The tunneling maneuver is rapid, is associated with little patient discomfort, and in a series of 25 consecutive patients has not been associated with hematoma formation.